Thrombotic microangiopathy and disseminated intravascular coagulation in a patient with carcinomatosis of the bone marrow due to gastric adenocarcinoma: Case report

Rom J Intern Med. 2023 Jun 30;61(3):167-174. doi: 10.2478/rjim-2023-0015. Print 2023 Sep 1.

Abstract

Carcinomatosis of the bone marrow is a rare clinical condition characterized by diffuse tumor infiltration of the bone marrow accompanied by hematological abnormalities, including thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC). In patients with gastric carcinoma, this association is infrequent. Below we present a case of a 19-year-old female patient with no known pathological history who presented with upper digestive tract bleeding. Upon examination, anemia and thrombocytopenia were documented, with schistocytes in the peripheral blood smear and prolonged coagulation times. Endoscopic studies indicated a lesion in the Borrmann IV gastric body, and the bone marrow biopsy showed the presence of signet ring cells. Because there was no possibility of systemic therapy, the patient died during hospitalization. This case contributes to the medical literature by describing an unusual presentation of a very frequent pathology.

Keywords: Bone marrow diseases; Disseminated intravascular coagulation; gastric cancer; signet ring cells; thrombotic microangiopathy.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma* / complications
  • Adult
  • Bone Marrow / pathology
  • Carcinoma* / complications
  • Carcinoma* / drug therapy
  • Carcinoma* / pathology
  • Disseminated Intravascular Coagulation* / etiology
  • Female
  • Humans
  • Stomach Neoplasms* / complications
  • Thrombotic Microangiopathies* / complications
  • Thrombotic Microangiopathies* / diagnosis
  • Young Adult